STACIA LYNN CHEADLE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004419

License Status

NOT RENEWED

Business

First Name

STACIA

Middle

LYNN

Last Name

CHEADLE

Business Name

STACIA LYNN CHEADLE

Original Issue Date

08/21/2012

Effective Date

01/29/2014

Expiration Date

03/01/2016

City

CHARLESTON

State

Zip

61920

County

COLES

Ever Disciplined

LastModifiedDate

05/22/2017